Adam Henig - Annual 2017101500115 -NFH -0115
Date Initial Filing
Received
CALIFORNIA • - 1 1 STATEMENT OF ECONOMIC INTERESTS
Official Use Only
POLITICAL FAIR • •
E -Filed
A PUBLIC D. CUMENT
COVER PAGE
015:10:51$
Filing ID:
Please type or print in ink.
168430967
NAME OF FILER (LAST)
(FIRST)
(MIDDLE)
Henig, Adam
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Gilroy
Division, Board, Department, District, if applicable
Your Position
Recreation
Recreation Manager
► If filing for multiple positions, list below or on an attachment.
(Do not use acronyms)
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County
❑ County of
x City of Gilroy
❑
❑ Other
3. Type of Statement (Check at least one box)
x❑ Annual: The period covered is January 1, 2017, through ❑ Leaving Office: Date Left
December 31, 2017 (Check one)
-or-
The period covered Is 02 / 02 / 2017, through O The period covered is January 1, 2017, through the date of
December 31, 2017 leaving office.
❑ Assuming Office: Date assumed I / O The period covered is // through the date
of leaving office.
❑ Candidate:Date of Election and office sought, if different than Part 1:
14. Schedule Summary (must complete) ► Total number of pages including this cover page: 2
Schedules attached
❑ Schedule A -1 - Investments — schedule attached ❑ Schedule C - Income, Loans, & Business Positions — schedule attached
❑Schedule A -2 - Investments — schedule attached ❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule B - Real Property — schedule attached ❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
-or-
F1 None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
7351 Rosanna Street Gilroy CA 95020
DAYTIME TELEPHONE NUMBER E -MAIL ADDRESS
( 408 ) 846 -0577 adam.henig @cityofgilroy.org
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed 02/01/2018
(month, day, year)
Signature Adam Henig
(File the originally signed statement with your filing official.)
FPPC Form 700 (2017/2018)
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
101500115 -NFH -0115
SCHEDULE A -2 CALIFORNIAFORM
Investments, Income, and Assets FAIR POLITICAL PRACTICES COMMISSION
of Business Entities /Trusts Name
(Ownership Interest is 10% or Greater) Henig, Adam
10- 1. BUSINESS ENTITY OR TRUST
Adam Henig (author /speaker)
Name
P.O. Box 1544
San Martin, CA 95046
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 X❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
Author of two nonfiction books. Earn monthly
royalties. Paid speaker too.
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 - $1,999
❑ $2,000 - $10,000 ��-
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑X Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
SHARE OF -• SS INCOME TO THE ENTITY/TRUST)
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑ OVER $100,000
❑X $1,001 - $10,000
1p- 3. LIST THE NAME OF ••- TABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a sepamteshmtifi-c-sary.)
❑
X None or ❑ Names listed below
PROPERTY li� 4. INVESTMENTS AND INTERESTS IN REAL OR
LEASED W THE BUSINESS ENTITY OR
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity a
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
Comments:
10- 1. BUSINESS ENTITY OR
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 -$1,999
❑ $2,000 - $10,000 ��-
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
IDENTIFY -• • ME RECEIVED (INCLUDE YOUR • RATA
SHARE OF -• SS INCOME TO THE ENTITY/TRUST)
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
1p- 3. LIST THE NAME OF ••- TABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a sepamte shmt if mc-sary.)
❑ None or ❑ Names listed below
1p- 4. INVESTMENTS • INTERESTS IN REAL PROPERTY • LEASED : THE BUSINESS ENTITY •-
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 ��-
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
FPPC Form 700 (2017/2018) Sch. A -2
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline:866 /275 -3772 www.fppc.ca.gov